TESDA-SOP-CACO-07-F21

TECHNICAL EDUCATION AND SKILLS DEVELOPMENT AUTHORITY

Pangasiwaan sa Edukasyong Teknikal at Pagpapaunlad ng Kasanayan

APPLICATION FORM
TESDA-SOP-CACO-07-F23
REFERENCE NUMBER : 1 4 0 4 0 3 1 2 1 0 0 0 0 0 1
YY Region Province Number Series Number Series
Assigned to AC

to be filled – out by the Processing Officer

Technical Education and Skills Development Authority
ASSESSMENT AND CERTIFICATION PROGRAM PICTURE
colored,
passport size,
Applicant’s Signature Date
ATTENDANCE SHEET
white
CAREGIVING (CLIENTS WITH SPECIAL NEEDS) NC II
background

Name of Competency THE BIG FIVE TRAINING AND ASSESSMENT

Name of School/Training Center/Company:
Assessment Center: CENTER INC.
Address: Date of Assessment:
No. applied CANDIDATE’S
Title of Assessment for: NAME Signature Assessment Results
1. CATINDIG, JOSIE LYNN A.
 Full Qualification  COC
1. Client Type2. YATCO, ROBERT T.
 TVET Graduating DIMAPILIS, CAMILLE
3. Student A.
 TVET graduate  Industry worker  SCEP

2. Profile 4. DELOS REYES, YESHA N.

2.
Name:
1. 5. EVANGELISTA, ANTON Z.

6. GUEVARRA, JAYZEE N.
SURNAME

FIRSTNAME 7. LIRIO, DAISELYN I.

MIDDLE NAME 8. MENDOZA, JASPER C. NAME EXTENSION (e.g. Jr., Sr.)

2. Mailing 9. PADILLA, JEROME H.

2. Address:
10.Number,REYES,
Street
JAYJAY O. Barangay District
Assessor/s:
City Province
TESDA
Region
Representative: Zip Code
2.3. Mother’s Name Grace Ann Sanchez 2.4. Father’s Name
2.5. Sex Signature over
2.6. Civil Printed Name
Status 2.7. Contact Number(s)____________________________
2.8. Highest Educational 2.9. Employment
Accreditation Number: Signature over Printed Name
Attainment Status
 Male
 Single Tel:
 Elementary graduate
 Casual

  Married Mobil  
Female ____________________________ e:
HS graduate
___________________________
Contractual
Signature
 over Printed Name E-  TVETover
Signature  Job Order
Printed Name
Widow/er Graduate
mail:
 Separated
Accreditation Number: ___________
Fax:
 College Level
 Probationary

Other  College Graduate

 Permanent
s:
 Others:  Self - Employed
_______________
 OFW
2.1 Birth 2.1 Ag
2.10 Birth date: M M D D Y Y
1 place: 1 e:
4. Other Training/Seminars Attended (National Qualification-related)
4.1. 4.2. 4.3. 4.4 4.5
Title Venue Inclusive Dates No. of Hours Conducted By

(For more information, please use separate sheet)

5. Licensure Examination(s) Passed

5.1. 5.2. 5.3. 5.4. 5.5. 5.6.
Year
Title Taken Examination Venue Rating Remarks Expiry Date

(For more information, please use separate sheet)

6. Competency Assessment(s) Passed

6.1. 6.2. 6.3 6.4. 6.5. 6.6.
Qualificati
Title on Level Industry Sector Certificate Number Date of Issuance Expiration Date

(For more information, , please use separate sheet)

ADMISSION SLIP
REFERENCE NUMBER :

Name of Applicant: Tel. Number:

Assessment Applied for:

Official Receipt Number:
Date Issued:
PICTURE
To be accomplished by the Processing Officer (Passport
Name of Assessment Center: size)
Check submitted requirements: Remarks:

 Bring own Personal Protective Equipment

 Accomplished Self-Assessment
Guide

 Three (3) pieces colored passport size pictures

 Others. Pls. specify
Assessment Date: Assessment Time:
 Printed Name & Signature of Processing Officer Printed Name & Signature of Applicant

Date: Date:

Note: Please bring this Admission Slip on your assessment date.

 QUESTIONING TOOL W/ MODEL ANSWER
RATING SHEET FOR ORAL QUESTIONING

Satisfactory
Questions to probe the candidate’s underpinning response
knowledge
Yes No
Extension/Reflection Questions
1. What is the main goal of CPR?
2. What are the care for shock?
Safety Questions
1. What is the importance of handwashing technique?
2. What is the importance of proper hygiene in feeding?
Contingency Questions
1. What is the meaning of BSI?
2. When to STOP CPR?
Infrequent Events
1. What is the importance of therapeutic communication?
Rules and Regulations
1. What is the meaning of OHS?
2. Why you need to be gentle ang respectful to client?
The candidate’s underpinning  Satisfactory  Not Satisfactory
knowledge was:
Feedback to candidate
General comments [Strengths / Improvements needed]

Candidate
Date:
signature:
Assessor
Date:
signature:

MODEL ANSWER:
 Extension/Reflection Questions
1. What is the main goal of CPR?
Answer: in performing for blood & oxygen flowing in CPR vital organs especially
the brain
2. What are the care for shock?
Answer: Proper body temperature,Proper body Position,Proper body transfer

Safety Questions
1. What is the importance of handwashing technique?
Answer: Preventing the spread of infection

2. What is the importance of proper hygiene in feeding?

Answer: Avoid Germs and avoid infection
Contingency Questions
1. What is the meaning of BSI?
Answer: Basic substance isolation – personal hygiene(wash hand,change
cloth,isolate yourself), cleaning & disinfecting of medical equipment, proper
disposal of PPE
2. When to STOP CPR?
Answer: spontaneous circulation,turn over to medical personnel, operator is
exhausted,physician assumes responsibility
Infrequent Events
1. What is the importance of therapeutic communication?
Answer: Establish trust & rapport

Rules and Regulations

1. What is the meaning of OHS?
Answer: Occupational Health & Safety, Workplace safety & Occupational Health

1. Why you need to be gentle ang respectful to client?

Answer: For persons comfort and dignity
Trainer signature: Date:
 Competency Assessment Results Summary (CARS)

Candidate Name:

Assessor Name:

Title of Qualification/ Cluster of

Units of Competency
Date of
Assessment Center:
Assessment:

The performance of the candidate in the following unit(s) of competency and

corresponding assessment methods
Satisfactory Not Satisfactory
Unit of Competency Assessment Method
A. Demonstration / Observation
with Oral Questioning

B. Written Test/Interview

Note: Satisfactory Performance shall only be given to candidate who demonstrated successfully all the competencies
identified in the above-named Qualification/Cluster of Units of Competency.

 For issuance of NC/COC  For submission of

qFor re-assessment (pls.
Recommendatio Additional specify)
n (Indicate title/s of COC, if Full Qualification is not met)
documents
____________________________________ Specify:___________
______________________
____________________________________ _______________ ______________________

Did the candidate overall performance meet the required evidences/standards? q Yes q No
OVERALL EVALUATION q Competent q Not Yet Competent

General Comments [Strengths/Improvements needed]

Candidate signature: Date:

Assessor signature: Date:

Assessment Center
Date:
Manager signature
 Candidates Copy (please present this form to claim your NC/COC)

COMPETENCY ASSESSMENT RESULTS SUMMARY

Date
Name of Candidate:
Issued:
Name of Assessment Center: Date :

Assessment Results: q Competent q Not Yet Competent

 For issuance of NC/COC

(Indicate title/s of COC, if Full Qualification is not  For re-assessment
met)  For submission of (pls. specify)
Recommendation:
____________________________________ Additional documents ____________________
Specify:_________________
____________________________________ __________________
_______________

Assessed by: _______________________ Attested by: ____________________

Name and Signature Name and Signature

Date: Date: